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Complications Are Rare With Laparoscopic Myomectomy


 

SAN DIEGO — Complications occurred in 11% of 2,051 patients who underwent laparoscopic myomectomy, which compares favorably with a complication rate of 35% for myomectomy performed by laparotomy—a figure that has been reported in the literature, Rocco Spagnolo, M.D., said at an international congress of the Society of Laparoendoscopic Surgeons.

The new data come from the first large series of cases studied with a focus on complications from laparoscopic myomectomy. The multicenter Italian study reviewed patient records retrospectively and recorded complications prospectively, he said.

Experienced surgeons who had completed the learning curve for the procedure performed the surgeries using the same techniques.

Patients underwent single or multiple myomectomies for symptomatic myomas measuring at least 4 cm in diameter to treat abnormal bleeding in 45% of cases, pain or a pelvic mass in 28%, and infertility in 27%.

Minor complications such as fever, cystitis, and lesions due to uterine manipulation occurred in 9% of patients. Major complications were seen in 2%, according to Dr. Spagnolo of Rome.

Among the most serious complications were hemorrhages in 14 patients (0.7%), 3 of whom required transfusions (0.1%). Postoperative hematomas occurred in 0.5% of patients, one in the broad ligament and the others in the myomectomy scar. One patient suffered a bowel injury. Constant hypotension during surgery led to postoperative acute renal failure in one patient.

Surgeons found unexpected sarcomas in two patients. In one of these cases they immediately converted to laparotomy. In the other case, although the mass looked like an adenomyoma and a frozen section was negative for malignancy, the cancer was diagnosed later upon histologic examination.

Five other cases were converted to laparotomy: three due to anesthesia problems and two because of a lack of space and limited mobility. One case was converted to laparoscopic hysterectomy due to a large intraligamentous myoma occupying most of the lateral part of the uterus.

Two patients were readmitted for surgery. One with severe hemorrhage underwent laparoscopic hysterectomy, and the other had a hematoma in the broad ligament drained.

Among the 185 pregnancies that occurred after the surgery, one patient had a uterine rupture. A majority (65%) of patients who wanted to become pregnant were able to do so.

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